This invention relates to a laparoscopic instrument assembly. This invention also relates to a method for use in laparoscopic surgery.
Laparoscopy involves the piercing of the abdominal wall and the insertion of a tubular port member or laparoscopic cannula through the perforation. Various instruments may be inserted through the tubular member to perform surgical operations inside the abdomen.
Generally, upon the disposition of the first cannula or trocar sleeve so that it traverses the abdominal wall, the abdominal cavity is pressurized to distend the abdominal wall and provide a safety region between the wall and the body organs inside the cavity. Moreover, several perforations are made. One perforation receives a laparoscope which enables visual monitoring of organs and surgical activities inside the abdominal cavity. Other perforations serve for the insertion of different surgical instruments.
Laparoscopic surgery provides several advantages over conventional incision-based surgery. The laparoscopic perforations, in being substantially smaller than the incisions made during conventional operations, are less traumatic to the patient and provide for an accelerated recovery and convalescence. Hospital stays are minimized. Concomitantly, laparoscopic surgery is less time consuming and less expensive than conventional surgery for correcting the same problems.
Generally, laparoscopic surgery is performed with rigid instruments, the distal end portions of which are inserted into the patient's abdominal cavity through one or more tubular port members inserted in perforations formed in the abdominal wall. To enable the different laparoscopic surgical instruments to reach different locations within the abdominal cavity, the tubular cannulas are tilted or pivoted.
In a more recent development, the distal terminal portions of some laparoscopes are flexible and bendable under control of the surgeon by the manipulation of actuator members outside the patient. As in endoscopic surgery, surgical instruments such as biopsy forceps, graspers, trocars, suction devices, irrigators, scissors, cautery devices, staplers, suture applicators and clamps, may be inserted through one or more longitudinal channels in the laparoscopes or endoscopes. These instruments are at least partially flexible to enable them to flex with the bending type motions of the laparoscopes or endoscopes in which they are inserted.
It frequently occurs during laparoscopic surgery that an additional instrument is temporarily required. Inserting this extra instrument has usually involved either temporarily removing one of the other instruments or forming another perforation with a trocar. However, inasmuch as trocar manufacturers are marketing torcar sleeves of increasing large diameter, the possibility exists for introducing more than one instrument through the same laparoscopic cannula or port member. This possible procedure entails certain problems with respect to manipulating a plurality of instruments at essentially the same location.
A particular laparoscopic surgical procedure and associated instrument assembly is disclosed in U.S. patent application Ser. No. 07/972,508. That application is directed to an improved laparoscopic procedure and instrument for spreading convoluted and folded organic tissues to enable visual inspection and physical access to a potential surgical site. Generally, such access is conventionally achieved by initially attaching a first clamp to tissues on one side of the desired site and a second clamp to tissues on the opposite side of the site. The clamps are then pulled apart, by surgical assistants, to spread the tissues between the two clamps. This conventional procedure, although useful and effective in open surgery, is cumbersome in laparoscopic surgery, and could be streamlined.